摘要
目的探讨颅脑外伤或肿瘤等颅骨缺损患者行颅骨钛网修补术后钛网外露的治疗策略选择及对应疗效分析。方法回顾性分析2011年3月至2023年10月空军军医大学西京医院整形外科收治的65例颅骨缺损修补术后钛网外露患者的临床资料。根据患者外露创面感染程度、外露发生时长、外露面积大小、局部分泌物及培养情况、患者本身存在的危险因素等,个体化决定是否保留钛网或去除钛网。若存在明显的大范围外露及周边区感染,则去除钛网并清除感染病灶,覆盖创面后待Ⅱ期再次行颅骨修补。以患者术后钛网外露区伤口愈合情况作为疗效指标。患者于出院后1、3、6、12个月分别进行门诊复诊,随访伤口愈合、外观修复、生活质量情况。结果65例患者中,53例(81.5%)患者植入物外露同时伴有明显感染。6例局部感染的钛网修补患者通过非手术治疗最终痊愈,59例行手术治疗。手术患者中,12例患者通过局部旋转头皮瓣成功保住了钛网,47例去除了钛网并行皮瓣覆盖缺损创面,其中11例在术后12个月随访时,再次进行了钛网修补颅骨缺损;所有患者伤口愈合良好,生活质量无影响。结论颅骨缺损钛网修补术后钛网外露常伴随感染发生,彻底的清创换药是愈合的基础。仅伤口轻微感染的患者可以考虑保留钛网的非手术治疗;对于外露区小范围感染的患者可以选择彻底清创后局部皮瓣转移覆盖创面以保留原有钛网,或剪除局部钛网,保留大部分钛网。而对于明显的大范围外露及合并严重感染者,则必须完整拆除钛网并行皮瓣覆盖创面,远期可再次行颅骨缺损修补。经个体化治疗,患者伤口愈合良好,且不影响生活质量。
Objective To investigate the treatment strategy selection and corresponding curative effect analysis of titanium mesh exposure after titanium mesh for repair of skull defects in patients with skull defects such as craniocerebral trauma or tumor.Methods The clinical data of 65 patients with titanium mesh exposure after titanium mesh for repair of skull defects admitted to the Department of Plastic Surgery,Xijing Hospital,Air Force Medical University from March 2011 to October 2023 were retrospectively analyzed.According to the degree of infection of the exposed wound,the duration of exposure,the size of the exposed area,the local secretion and culture,and the risk factors of the patient,the individual decision was made whether to retain or remove the titanium mesh.If there was obvious large-scale exposure and infection in peripheral areas,the titanium mesh was removed and the infected lesion was cleared.After covering the wound,the skull repair was performed again in the second stage.The wound healing in the exposed area of titanium mesh after operation was taken as the curative effect index.The patients were followed up for wound healing,appearance repair and quality of life at 1,3,6 and 12 months after discharge.Results Of the 65 patients,53(81.5%)had implant exposure accompanied by significant infection.Six patients with local infection of titanium mesh repair were finally cured by non-surgical treatment,and 59 patients underwent surgical treatment.Among the surgical patients,12 patients successfully preserved the titanium mesh through the local rotation head flap.In 47 cases,titanium mesh was removed and skin flap was used to cover the defect wound.Among them,11 cases were followed up for 12 months after operation,and titanium mesh was used to repair skull defects again.All patients had good wound healing and no effect on quality of life.Conclusion The exposure of titanium mesh after titanium mesh for repair of skull defects is often accompanied by infection.Thorough debridement and dressing change is the basis of healing.Patients with only minor wound infection can consider non-surgical treatment with titanium mesh retention.For patients with a small area of infection in the exposed area,the local flap can be transferred to cover the wound after thorough debridement to retain the original titanium mesh,or the local titanium mesh can be cut off to retain most of the titanium mesh.For obvious large-scale exposure and severe infection,it is necessary to completely remove the titanium mesh and cover the wound with the flap,and the skull defects can be repaired again in the long term.After individualized treatment,the patient s wound heals well and does not affect the quality of life.
作者
权鑫
耿健
董立维
唐银科
谭晨
杜依晨
夏文森
马显杰
QUAN Xin;GENG Jian;DONG Liwei;TANG Yinke;TAN Chen;DU Yichen;XIA Wensen;MA Xianjie(Department of Plastic Surgery,Xijing Hospital,Air Force Medical University,Xi'an 710032,China)
出处
《空军军医大学学报》
CAS
2024年第8期891-894,共4页
Journal of Air Force Medical University
基金
国家自然科学基金青年科学基金(81801216)。
关键词
颅骨缺损
手术后并发症
颅骨钛网修补
钛网外露
皮瓣转移
skull defects
postoperative complications
skull titanium mesh repair
titanium mesh exposure
flap transfer
